Quality & Pricing Transparency

Pricing Questions

In an era of increasing health care costs and consumer-driven financing alternatives, the need for pricing transparency in health care services has taken on increasing importance. The goal of pricing transparency is to provide useful information about our health care facilities on a comparative basis across the various services provided.

Hospital Pricing at Avera

Avera Health is committed to sharing information in ways that will help you make informed decisions about health care services. However, issues surrounding hospital pricing remain complex and include many factors, such as:

Prices vary based on patient needs and the level of services consumed.

A wide range of products and services are bundled into the price of a particular hospital service, including medications, supplies, tests and more.

Hospital reimbursement varies from patient to patient based on the payments mandated by different insurance companies, health plans, and government payors such as Medicare and Medicaid.

All of these factors combine to make specific advance pricing information difficult to provide on an individual basis.

Yet, Avera supports the goal of pricing transparency for health care services and strives to provide meaningful information with the goal of providing efficient and effective outcomes for all patients.

Role of the Payor Community

Because traditional insurance typically covers most of the cost of hospital care, patients with this type of coverage are more likely to be interested in what their personal out-of-pocket costs would be between hospitals, rather than overall hospital charges.

Insurance companies should follow the same path as the provider community in making patient out-of-pocket obligations publicly available on the comparative basis, as well as the differences between payments to individual hospitals.

Role of Other Health Care Payors

Avera is committed to responding to the needs of individuals, beyond those with traditional insurance coverage.

Patients with high-deductible health savings accounts (HSA) will probably be most interested in specific price information including ambulatory care and physician visits where they could be responsible for paying the entire cost of care.

Patients with Health Maintenance Organization (HMO) coverage have agreed in advance to limit their choice of hospitals and physicians and will have less need for specific price information.

Patients without insurance who have limited means of paying for health care will want to compare information, but ultimately will need to work within the charity and discount policies that are available.Learn more about charity and patient assistance programs at Avera.

Role of the Vendor Community

Many costs related to hospital pricing are outside the control of Avera. These include product mark-ups for device manufacturers, pharmaceuticals and other medical service providers. Vendors should also be encouraged to supply a transparent price list to help patients recognize the costs associated with health care services and procedures.

Refund Policy

Hospital accounts are reviewed monthly to determine if any refunds are due. If it is determined that a refund is due to a patient, the accounts receivable clerk will check to see if the patient has an outstanding balance. If so, the refund amount is applied to the outstanding account. If there is no outstanding balance, a refund check is sent to the patient.

Our Commitment

Avera is committed to providing high-quality health care and pricing transparency. Our ongoing efforts in pricing transparency will focus on improving the quality of care while being mindful of the costs to our patients.